cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关因素

 目的　探讨cN0甲状腺乳头状癌侧颈淋巴结转移特点及其相关危险因素。方法　回顾性分析73例接受同侧预防性颈清扫（Ⅱ～Ⅵ区或Ⅱ～Ⅳ区联合Ⅵ区）的cN0甲状腺乳头状癌患者临床资料，颈清扫淋巴结标本按颈部分区收集并送术后常规病理检查。 结果　73例cN0甲状腺乳头状癌患者中，侧颈淋巴结转移率为16.4 ％（12／73），其中Ⅱa、Ⅱb、Ⅲ、Ⅳ、Va、Vb和Ⅵ区淋巴结转移率分别为9.6 %、0、13.6 %、9.6 %、0、4.8 ％和42.4 %，多因素分析显示Ⅵ区淋巴结转移是影响cN0甲状腺乳头状癌侧颈淋巴结转移的独立危险因素（OR＝7.3，P＝0.020）。结论　cN0甲状腺乳头状癌侧颈转移以Ⅱa、Ⅲ、Ⅳ区为主，预防性清扫应重点清扫上述三个分区；术中冷冻Ⅵ区阴性时，cN0甲状腺乳头状癌患者无需常规行侧颈预防性清扫。

Pattern and related factors of lateral cervical lymph node metastasis in patients with cNo papillarythyroid carcinoma

Objective To evaluate the pattern of lateral cervical metastases and to investigate the risk factors for lateral cervical lymph node metastases in paoiuary thyroid carcinoma patients with clinical negative lateral neck lymph node. Methods 73 patients with paoiuary thyroid carcinoma who underwent prophylactic lateral neck dissections （level Ⅱ-Ⅳ or level Ⅰ-Ⅳ and Ⅳ） were reviewed retrospectively on their medical records paoiuary thyroid carcinoma. None of patients in this study had a clinically positive lymph node. Neck dissection specimens were obtained for histological analysis for node metastasis with respect to the individual neck levels. Results Occult metastases in lateral neck were observed in 12（16.4 %） patients. 9.6 %, 0, 13.6 %, 9.6 %, 0, 4.8 % and 42.4 % patients had histologically positive lymph nodes in levels 11 a, Ⅱa, Ⅱb, Ⅳ, Ⅴa, Ⅴb and VI respectively. In multivariate analysis, lymphatic metastases in level Ⅵ was associated with lateral neck metastasis（OR=7.3,P=0.020） in cN0 patients with paoiuary thyroid carcinoma. Conclusion Levels Ⅲ, Ⅱ a and IV were the most common stages showing occult lymph node metastases. Prophylactic lateral neck dissections may be omitted in the treatment of cN0 PTC patients if level VI lymphatic metastases are not found on histological exam.